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Black Triangles Between My Teeth

Will Orthodontic Treatment Cause Black Triangles Between My Teeth?

By Dental Care, Orthodontics No Comments

If you’ve been considering orthodontic treatment, you might have heard or read about the possibility of developing back triangles in your teeth after braces or Invisalign®. But what are black triangles? And does orthodontic treatment actually cause them? The team at Richard Chan Orthodontics will be covering everything you need to know.

What are Black Triangles Between Teeth?

Ideally, there is a piece of gum tissue, known as an interdental papilla (papillae plural), that extends from the gumline and sits between two teeth, firmly attaching to both. In the front of the mouth, the papillae are shaped like pyramids, or triangles. They keep the tooth roots safe and prevent food from getting stuck between the teeth and causing decay and cavities. 

When the papillae don’t project from the gum line and fill the space between the teeth, it creates a triangular void between the teeth and the gumline. This is what people sometimes refer to as a black triangle. 

In a study published in the European Journal of Prosthodontics and Restorative Dentistry, participants ranked black triangles between the teeth, technically called open gingival embrasures or gingival triangles, as the third most disliked smile aesthetic issue after cavities and crown margins.

While black triangles do compromise the appearance of your smile, it’s not merely a cosmetic problem. Depending on the size of the space, it can increase your risk of tooth decay and gum disease. It may also interfere with your ability to properly produce certain speech sounds. 

What Causes Black Triangles in Teeth?

According to a literature review in the British Dental Journal, there are a number of causes of black triangles in teeth and they often develop because of a mixture of factors, including:

  • The amount of space between teeth
    You need enough width between the teeth to facilitate blood flow to the papillae but not so much space that the tissue is stretched or unable to fill in the area.
  • Genetics
    Inherited traits like the natural shape and position of your tooth roots, as well as the distance between the jawbone and the first point of contact between two teeth can make you susceptible to black triangles.
    The shape of your teeth, which is also genetic, plays a role too. People with square or rectangular-shaped teeth tend to have better contact between teeth from top to bottom when the teeth are properly spaced. Triangular-shaped teeth, on the other hand, often meet closer to the chewing surfaces where they’re wider, but as the teeth narrow towards the gumline, a black space can occur.
  • Your age
    The risk increases with age and certain systemic diseases like osteoporosis.
  • Your gum biotype
    People with thin, scalloped gums are more likely to develop black triangles, because this gum biotype responds to trauma and inflammation by receding. A thick, flat gum biotype often means the gums have greater blood flow and are better able to withstand inflammation, which helps keep the papillae in place.
  • The presence of periodontal (gum) disease and gum recession
    As the gums recede, the papillae will also recede and can begin to lose attachment with the teeth, creating black triangles.
  • Diverging tooth roots
    This is when the tooth roots are spaced or angled in a way that creates space between the teeth near the gumline.
  • Misshapen dental restorations
    Crowns or other restorations that aren’t the correct size and shape can lead to a space between the teeth.
  • Poor oral habits
    Nail biting, excessive toothpick use, and aggressive flossing can damage the papillae and/or cause gum recession.

Do Braces and Invisalign Cause Black Triangles?

No, Invisalign and braces do not cause black triangles in between the teeth. There is a misconception that it can be a consequence of orthodontic treatment. But the truth is, when teeth are crowded, crooked, or overlapping, the black triangles aren’t visible. 

As your braces or Invisalign aligners straighten the teeth, black triangles can start to appear. This is simply because there isn’t enough gum tissue to fill in the space where the crowded or rotated teeth used to be. So if you have new black triangles in your teeth after Invisalign or braces it’s likely becuase orthodontic treatment revealed an existing issue. 

When you visit Richard Chan Orthodontics, we assess your teeth, gums, and bite before you start treatment. Dr. Richard Chan then creates a personalized treatment plan based on your unique dental and facial anatomy. He may take certain steps or coordinate with your dentist to minimize or prevent black triangles and create your ideal smile.

How Can I Prevent Black Triangles in My Teeth After Braces or Invisalign?

While you can’t do anything about genetics, your age, or your gum biotype, there are things you can control, including keeping your gums healthy to ward off recession. 

Black triangles, or open gingival embrasures, are frequently an early sign of gum disease. If Dr. Chan believes you have gum disease, you’ll need to have it treated prior to beginning orthodontic treatment.

Once you get braces or Invisalign, it’s important to maintain excellent oral hygiene. To keep gums healthy and reduce your risk of black triangles:

  • Brush your teeth with a soft-bristled toothbrush and fluoride toothpaste in the morning and after all meals and snacks for two full minutes each time. If you have braces, pay extra attention to the tight areas around your brackets and the space between your brackets and gumline. Be sure to gently massage your gums while you brush as well to keep them stimulated and prevent swelling.
  • Floss at least once per day.
  • In addition to flossing with dental floss, you may want to consider using a water flosser too. This will help remove even more plaque and food debris and stimulate your gums. 
  • Ask Dr. Chan about including an antibacterial mouthwash into your daily routine. He can recommend a rinse that fights plaque and boosts gum health if needed. 
  • Avoid biting your nails or using toothpicks excessively. When you floss, be gentle with your gums. 
  • Continue to see your general dentist for routine dental exams and cleanings once every six months during your braces or Invisalign treatment. 

How to Fix Black Triangles in Teeth

If you do notice black triangles, there are solutions. The best treatment for you will depend on the underlying cause and your individual needs. Dr. Chan and/or your dentist can make personalized recommendations for how to fix black triangles in your teeth in a way that will promote good oral health. 

Options could include:

  • Orthodontic treatment. In some cases, when gum disease isn’t the culprit, orthodontic treatment can actually fix black triangles. In these instances, once the teeth are properly aligned, the unwanted voids will be eliminated. Plus, straight teeth are easier to keep clean, which reduces your risk of gum disease and recession going forward.
  • Interproximal reduction. If the shape of your teeth is behind black triangles, this technique can be used to gently file down enamel. Once your teeth are reshaped, we can use braces or Invisalign to shift them into place. They’ll then be flush against one another and the black triangles will disappear.
  • Cosmetic dentistry. A dentist can enhance a tooth, or teeth, with bonding materials to eliminate or reduce black triangles. Dental crowns, veneers, and recontouring procedures could also be possibilities.
  • Hyaluronic acid. Similar to cosmetic facial fillers, hyaluronic acid can also be injected into the gum tissue to add volume and encourage the tissue to fill in the space between the teeth.
  • Grafting or tissue engineering. For severe gum recession or disease, your dentist might recommend attempting to regrow gum tissue. This can be achieved through procedures such as gum grafting and tissue engineering.
  • Other options. There are other options as well that you may want to discuss with your dentist. These can include using pink restorations or gingival veneers to hide the black triangles. 

Say Goodbye to Black Triangles

Want to find out if orthodontic treatment can fix black triangles between your teeth? Or are you looking for an experienced orthodontist who can create a treatment plan that helps you avoid them? Richard Chan Orthodontics has you covered! Schedule a visit with our Juneau, AK and Bothell, Monroe, and Mill Creek, WA orthodontist today.

Rapid Palatal Expanders

Everything Parents Should Know About Rapid Palatal Expanders

By Orthodontics No Comments

Braces and Invisalign® Teen are both really effective orthodontic treatments. But they can’t always do the job on their own. When a patient has a small or narrow upper jaw, sometimes, an appliance called a rapid palatal expander is needed for skeletal correction, either before or during comprehensive treatment. 

While there are ways to expand an adult’s upper jaw, a rapid palate expander is generally used for kids and teens who are still growing. Since their skeleton is developing and flexible, guiding jaw growth is much easier. 

In this post, the experts at Richard Chan Orthodontics will be sharing everything parents need to know about treatment with an orthodontic expander. 

Rapid Palatal ExpanderWhat is a Rapid Palatal Expander?

A rapid palatal expander (RPE) is a common orthodontic appliance used in phase 1 orthodontic treatment or comprehensive treatment with expansion. Though there are removable palatal expanders, fixed expanders, meaning the appliance stays in place until expansion is complete, are often preferable for younger patients. 

The maxilla (the bone of the upper jaw) is made up of two pieces that don’t fuse together until the mid-teenage years. A palatal expander uses gentle pressure to separate the pieces and widen the palate. 

This can help make room for all of the permanent teeth to fit properly and fixes discrepancies between the upper and lower jaw to create an ideal bite (the way the top and bottom teeth come together). 

How Does an Orthodontic Expander Work?

The device is secured around the back teeth and has two halves that fit against the roof of the mouth. The halves are joined together with a screw at the center. 

You or your child will activate the expander by placing a key in the screw and turning it. Each turn creates tension that exerts gentle pressure on the midline suture, the point where the two maxillary bones meet, and the molars. This pressure pushes the maxillary bones apart and widens the jaw. 

Once your child reaches the prescribed amount of expansion, the appliance will stay in place for several months so new bone can form between the halves of the maxilla, making the expansion permanent. 

As we said above, an expander might be used during early orthodontic treatment before a child has all of their permanent teeth. Normally, however, the expander is used during a comprehensive treatment plan, where the child wears an expander for about six months before we remove it. Immediately after the expansion is completed, orthodontic treatment with braces or Invisalign Teen is used to fine tune the bite and straighten the teeth. 

At Richard Chan Orthodontics, we always treat kids conservatively. And, while there are cases where two phases of treatment are needed, more often than not, we can achieve the same results with a single phase of treatment. Therefore, Dr. Chan may recommend combining an expander with braces. When the goals for expansion are achieved, he’ll take the expander out and your child will continue with braces

When is a Rapid Palate Expander Needed?

There are other instances where an expander could be needed, such as certain cases of an underbite, but these are the most common reasons kids and teens require maxillary expansion:

A Crossbite 

A crossbite is when some of the bottom teeth sit outside of the top teeth. A crossbite can be anterior (involving front teeth) or posterior (involving teeth in the back). Often, a posterior crossbite that’s skeletal in nature is due to the upper jaw being too narrow in relation to the lower jaw. 

When that’s the case, expansion could be the best course of action. If not treated, patients with a posterior crossbite can compensate by shifting their jaw to the side, causing permanent changes in their facial structure. Crossbites can also result in jaw and TMJ pain and worn teeth. 

Airway Issues

Breathing through the nose helps the lungs absorb oxygen, filters out impurities, adds moisture to the air, and even plays an essential role in kids’ growth. When nasal breathing isn’t possible and kids resort to mouth breathing, it has a negative impact on the development of their jaw and facial structures and can lead to sleep-disordered breathing, which includes obstructive sleep apnea. 

Upper expansion widens the nasal floor (the palate is the floor of the nose), makes more room for the tongue and permanent teeth, and helps open the airway. This can enable kids to breathe easier, prevent or reduce sleep-disordered breathing and the associated side effects, and stop mouth breathing from impacting their appearance and health as an adult. 

Severe Crowding

Crowding occurs when the jaw is too small to fit all of the permanent teeth. Teeth might twist, overlap, or even become impacted (stuck beneath the bone). Crowded, crooked teeth are harder to clean, which increases the risk of tooth decay and gum disease. Crowding can also cause uneven wear and interfere with function. 

By widening the upper jaw with an expander, the teeth will have enough space and extractions can be avoided. Expansion may also create room for impacted teeth (commonly the canine teeth) to erupt without needing oral surgical procedures or extractions.

How Long Does Expansion Take?

The actual expansion only takes a few weeks. But the expander needs to stay in place for a while longer to give new bone time to form in the space between the maxillary bones. This is what stabilizes the expansion. On average, patients wear an expander for about six months. 

Does a Rapid Palatal Expander Hurt?

We know, the idea of palate expansion does seem a little intense. But, because the maxillary bones in kids and teens aren’t fused together, manipulating them isn’t painful and only a small amount of tension is needed to shift them apart. 

That said, while your child won’t feel severe pain from a rapid palatal expander, they may have mild soreness and pressure after turning the key, particularly during the first several days. 

To keep them comfortable, have them stick with a liquid diet (soup, smoothies, etc.) for the first day and then soft foods for a couple of days to a week. It’s also a good idea to activate the expander at night, so by the time your child wakes up, most of the pressure is gone. 

Are There Other Side Effects From an Expander?

Chewing and speaking can feel weird at first. Within a few days, your child or teen will get used to having the expander in their mouth and their ability to chew and speak will return to normal. 

If you notice a space forming between your child’s front teeth, have no fear! This is completely normal and a sign that the expander is working and their jaw is widening. We’ll close the gap with braces or Invisalign.

How to Adjust an Expander

Dr. Chan will show you and your child how to adjust an expander. Sometimes it can take doing it yourself a few times to feel confident, but, we promise, it’s simple. Here’s how to activate the expander:

  • Tip the head back. 
  • Have someone help shine a light into the mouth so you can see better.
  • Put the key Dr. Chan gave you into the hole at the front center of the appliance.
  • Push the key toward the back of the mouth until it stops and you can see the next hole.
  • Carefully remove the key from the mouth. You should be able to clearly see the new hole for the next turn.

Depending on your child’s age, Dr. Chan may recommend either two turns per day (usually for older children/teenagers), or one turn every other day (usually for younger children). He will inform you how often and how many turns total. 

What Happens if You Turn an Expander Too Much?

Patients are sometimes curious about what happens if you turn your expander too much. Turning the expander more than prescribed will compromise the results and cause more discomfort. It will not speed up treatment. 

What if My Child Forgets to Activate Their Expander?

If your child forgets to activate their expander, do not do two turns the next time. Keep going with one turn per time, and add the missed turn to the end. While missing one turn isn’t a huge deal, be sure to keep in mind that adjusting the expander according to Dr. Chan’s directions will keep your child’s treatment plan on schedule. 

How to Take Care of an Expander

Orthodontic appliances give food debris and plaque more places to hide. So, when wearing an expander, have your child or teen brush their teeth in the morning, after meals and snacks, and before bed. They should continue flossing once daily too. 

Kids will want to gently brush their expander, including the screw and bars, when they brush their teeth. If they’re at school or out somewhere and forget their toothbrush, they can swish with water to keep the appliance clean until they can brush again. 

As for eating with an expander, the food restrictions are similar to those kids have with braces. Avoid anything really hard, chewy, or sticky like whole, raw apples, caramels, hard pizza crust, gum, and licorice.

What are the Benefits of Expansion?

When a rapid palatal expander is necessary, the benefits are significant. Expansion can:

  • Help kids and teens avoid the need for corrective jaw surgery
  • Prevent the need for tooth extractions
  • Open the airway and encourage nasal breathing 
  • Guide growth to correct a crossbite, crowding, and other skeletal concerns
  • Create a wider, more aesthetically pleasing smile
  • Make room for impacted teeth to erupt on their own

Schedule a complimentary consultation at Richard Chan Orthodontics in Bothell, Monroe, and Mill Creek, WA or Juneau, AK to get personalized treatment recommendations for your child or teenager. If a rapid palate expander is needed, Dr. Chan will walk you through his diagnosis, the process, and what to expect, so you feel fully informed about your child’s smile journey.

8 Ways to Celebrate Getting Your Braces Off in Juneau, AK

By Community, Orthodontics No Comments

 Getting your braces off or finishing Invisalign® treatment is a big deal! After committing to taking care of your teeth and your appliance, you’ll have a fantastic smile to show for your efforts. 

Of course, if you’re a patient at Richard Chan Orthodontics, we’ll make you feel special when your treatment is complete. But we also think it’s a great idea to mark the occasion with your friends and family too. 

Not sure how to celebrate getting your braces off? Our Juneau, AK orthodontist is sharing eight fun ideas!

1. Enjoy Some Braces Un-Friendly Foods 

As you’re well aware, there are certain foods to avoid with braces, including anything really hard, chewy or sticky, such as popcorn, gum, licorice, hard candy, nuts, caramel and toffee. When your braces are removed, go ahead and indulge in the food you missed during treatment (in moderation, of course). Here are a few places to get treats in Juneau:

  •  Alaskan Fudge Company – 195 S. Franklin St., Juneau, AK – Try the delicious, homemade fudge, cashew brittle or chocolate covered pecans without worrying about breaking a braces bracket. 
  •  Coppa – Get a baked good or grab a pint of ice cream since all flavors are back on the menu!
  •  Zerelda’s Bistro – 9106 Mendenhall Mall Rd, Ste B, Juneau, AK – Zerelda’s freshly baked desserts are perfect for celebrating the end of orthodontic treatment. 
  • Alaskan Sweet Thing’s – Treat yourself to some candy or their gourmet popcorn. You can order online or find the popcorn and sweets in these Alaskan retail stores

2. Go Out for a Celebratory Meal 

Speaking of food, go out to eat or get some takeout from a Juneau restaurant. How exciting will it be to not worry about what you can eat on the menu or have to take your Invisalign aligners out before your meal? Try:

3. Whiten Your Teeth     

When your braces come off or you remove your last Invisalign tray, round out your smile makeover with whitening treatment. While over-the-counter products may get you a few shades brighter, professional whitening with your dentist will give you much more dramatic results for the straight, white teeth of your dreams. 

4. Do a Photoshoot     

Whether you have a friend take pictures or you hire a professional photographer, you’ll want to capture your brand-new smile. 

5. Throw a Party

Throw a braces off party to show off your results. Be sure to serve some of the things you couldn’t eat with braces. 

6. Go on an Adventure

After finishing Invisalign or braces treatment, you deserve a daycation. Play tourist in Juneau for a day and visit some of your favorite spots, eat amazing food and take part in fun activities (we have a round-up of things to do in Juneau in the winter, here). Alaska.org also has some excellent recommendations

7. Highlight Your Smile

Reward yourself with something that complements or highlights your healthy, beautiful smile. Get a facial at a Juneau spa or head to a barbershop or salon for a fresh haircut. Book a visit at:

8. Laugh and Smile! 

If you felt self-conscious about your smile before braces or Invisalign, make up for lost time by finding as many reasons to laugh and smile as possible. A good starting point? Catch a comedy at Goldtown Theater or Glacier Cinema

Ready for a Smile You’ll Want to Celebrate?

Now that you know how to celebrate getting your braces off, we hope you end your smile journey on a high note.

If you haven’t started treatment yet, schedule a complimentary consultation with our Juneau orthodontist, Dr. Richard Chan, today!


When Can I Wear My Retainer After Wisdom Tooth Removal?

By Orthodontics No Comments

If your third molars, or wisdom teeth, are impacted or causing complications, having them extracted can benefit your oral health. But, as you probably know, wisdom tooth removal is a type of oral surgery and, of course, there will be a healing period after the procedure.

During your recovery, you’ll avoid brushing around the extraction sites, vigorous swishing and spitting, using a straw, and eating hard foods, among other things.

But what about putting in your removable retainer? If you have one, you might be asking, “When can I wear my retainer after wisdom tooth removal?” Our Juneau, AK and Bothell, Monroe and Mill Creek, WA orthodontist Dr. Richard Chan has answers!

When Can I Wear My Retainer After Getting My Wisdom Teeth Taken Out?

Since you’re concerned about when you can wear your retainer after wisdom tooth removal, we’re guessing that means you know just how important the appliance is. And, it’s true, wearing an orthodontic retainer after braces or Invisalign® treatment is the only way to maintain your results. 

But, proper healing and managing pain and swelling are the main priorities after having your wisdom teeth removed. If your oral surgeon’s after-care instructions mention when you can wear your retainer again, follow those guidelines. 

Otherwise, wait a full 24 hours after surgery before attempting to put in your retainer. You don’t want to inadvertently irritate the extraction sites or dislodge clots. After 24 hours, you can try your retainer whenever you feel ready. If it’s comfortable and doesn’t cause any pain, you’re good to go! Just be sure to keep it clean, so you’re not introducing any extra bacteria into your mouth. 

Most people feel back to normal within three days to a week after wisdom tooth removal, depending on the complexity of their case. So, even if your first attempt at wearing your retainer is uncomfortable, it’s very likely you won’t have to wait too long before you feel well enough to try again. 

Will My Retainer Still Fit After Wisdom Tooth Removal?

Generally, yes! The majority of patients finish braces or Invisalign treatment before their wisdom teeth erupt, which usually happens between the ages of 17 and 21.

If you were one of our teenage Juneau, Bothell, Monroe or Mill Creek braces or Invisalign patients, we probably created a custom, 3D-printed, clear plastic retainer for you to wear when you finished treatment. The retainer was designed to fit your pre-wisdom teeth smile. 

As we said in our blog post on wisdom teeth and braces, when the wisdom teeth come in, they don’t exert enough pressure to shift nearby teeth. So, these molars erupting or being removed won’t change the way your clear retainer fits. 

While it will depend on the design of your specific retainer, the same usually holds true for Hawley retainers. These retainers, which have an acrylic base with a wire that wraps around the front of the teeth, are also designed for when you finish braces or Invisalign treatment, which usually occurs before you get your wisdom teeth. 

If you had your wisdom teeth when you underwent orthodontic treatment and the retainer you received fits over them, then you may need to have your retainer adjusted or a new one created to fit your smile once your wisdom teeth are gone. 

How Long Do You Have to Wear a Retainer?

Getting your wisdom teeth removed isn’t a sign you can stop wearing your retainer. While you’ll use your retainer most frequently in the months after finishing orthodontic treatment to lock in your results, your teeth can still shift even years later if you forgo it.

So, how long do you have to wear a retainer? Ideally, for life. The good news is, you’ll reach a point where you only need to wear it a few nights per week. If that’s the stage you’re at when you get your wisdom teeth taken out, you’ll have a little more wiggle room.

Otherwise, if you skip wearing your retainer for too long after wisdom tooth removal (or at any time!), your teeth will shift and your retainer will feel tight. Eventually, your retainer won’t fit at all. While you can get a new one, it will hold your teeth where they are. To move your teeth back to their post-treatment positions, you’ll need braces or Invisalign again. How Long Do You Have to Wear a Retainer?

Richard Chan Orthodontics Has Your Smile Covered

Have more questions about when you can wear your retainer after wisdom tooth removal? Reach out and we’ll be happy to help. 

If you need a new retainer or you’d like to touch-up your smile after forgetting to wear it, schedule a complimentary consultation at Richard Chan Orthodontics in Bothell, Monroe or Mill Creek, WA or Juneau, AK. 


What is a Crossbite and How is it Fixed?

By Dental Care, Orthodontics, Teen Orthodontics No Comments

As a board-certified orthodontist, Dr. Richard Chan is an expert in diagnosing, preventing and treating malocclusion, or an improper bite. There are different types of malocclusion and you’ve probably heard of a few of them like an overbite and underbite. One type that a lot of people are less familiar with is a crossbite. So, what is a crossbite? Our Juneau, Bothell, Monroe and Mill Creek orthodontist will be covering everything you need to know about this orthodontic concern.

What is a Crossbite?

Normally, your upper teeth overlap on the outside of the lower teeth when you close your jaws together. When you have a crossbite, however, one or more of your upper teeth bite inside of your lower teeth. A crossbite can involve several teeth or a single tooth and it can occur in the front of the mouth, back of the mouth or both. There are two main types of crossbites:

  • Anterior Crossbite: An anterior crossbite, or front crossbite, is when one or more front top teeth sit inside of the front bottom teeth.
  • Posterior Crossbite: A posterior crossbite, or back crossbite, is when one or more of the upper teeth in the back or on the side of the mouth sit inside of the lower teeth. A posterior crossbite can develop on one side of the mouth or, occasionally, both sides.

So, isn’t a crossbite the same as an underbite? No. With an underbite, the jaw and whole arch of top teeth are behind the bottom teeth.

What Causes a Crossbite?

  • Genetics The most common cause of a crossbite in children is genetics, which, unfortunately, means that many crossbites can’t be prevented. Usually, it’s a result of a small or narrow upper jaw and/or larger lower jaw, which can be inherited from one or both parents.
  • Delayed Loss of Baby Teeth When the baby teeth don’t fall out when they’re supposed to (over-retained primary teeth) and the permanent teeth are delayed in erupting, the other teeth may shift to compensate, creating misalignment, such as a crossbite.
  • Oral and Myofunctional Habits Oral habits like prolonged thumb sucking and pacifier use are another cause of malocclusion. The pressure from the thumb or pacifier can push teeth out of alignment and distort bone, resulting in a narrow palate and crossbite. Myofunctional problems like abnormal swallowing patterns can also cause a crossbite, because they too exert undue pressure.
  • Mouth Breathing Chronic mouth breathing in kids, which often happens at night, can impact jaw and facial development. It may lead to an elongated face and underdeveloped jaw, contributing to the development of a crossbite and other orthodontic concerns like crowding.
  • Cleft Lip or Cleft Palate A cleft lip and cleft palate happen when a baby’s lip or mouth doesn’t properly form when they’re in the womb. With a cleft lip, the sides of the lip don’t fuse during fetal development, while a cleft palate is when the roof of the mouth, or palate, doesn’t fuse completely, leaving an opening.Children with orofacial clefts are more likely to have dental issues. According to research published in BioMed Research International, the most common malocclusion among patients with total cleft of the lip, alveolar bone and palate was a crossbite.

Why Does a Crossbite Need to be Treated?

While it depends on the severity and type of crossbite, an untreated crossbite can lead to:

  • Excessive wear of the enamel and chipped or cracked teeth, because of the way the teeth come together when you bite down
  • Increased risk of tooth decay and gum disease, as misaligned teeth are harder to properly brush and floss
  • Gum recession, because certain teeth bear the brunt of the chewing forces. As gums recede, tooth roots are left exposed and vulnerable to decay and infection
  • Difficulty biting and chewing
  • Difficulty closing the mouth
  • Strain on the temporomandibular joints (TMJ) and chewing muscles, resulting in TMJ dysfunction and pain
  • Headaches and toothaches
  • Lopsided jaw growth since patients often compensate by shifting their jaw forward or to the side
  • Speech issues – a study found that a posterior crossbite can affect speech in children by altering the tongue position and making speech sound distorted

Does a Crossbite Require Interceptive Orthodontic Treatment?

Sometimes, a severe posterior crossbite does require interceptive orthodontic treatment, also called phase 1 orthodontic treatment. At Richard Chan Orthodontics, we rarely treat young children and can usually achieve excellent results with one phase of orthodontic treatment. However, there are cases where early interceptive treatment will help to prevent the lopsided jaw growth that can occur in patients with a crossbite.

In these instances, during phase 1 treatment, Dr. Chan uses certain orthodontic appliances, mostly commonly being a rapid palatal expander. A palatal expander is a fixed appliance that sits against the roof of the mouth. As you activate the expander by turning a key, it gently widens the upper jaw, which in children, consists of two halves that meet at the middle, called the midline suture. The suture isn’t yet fused, so the pressure from the device is able to shift the two halves of the jaw apart to correct the crossbite. 

When the desired amount of skeletal expansion is achieved, the appliance is left in for a bit longer so that new bone can form in the middle to stabilize the expansion. 

Dr. Chan removes the expander and then after a resting period where the remainder of the baby teeth fall out, the patient starts phase 2 orthodontic treatment, typically around age 12 or 13. During phase 2, we use braces or Invisalign Teen to straighten the teeth and ensure the bite is coming together properly.

Is Crossbite Correction Effective in Adults?

We can treat an anterior crossbite or a crossbite that is due to the position of the teeth at any age. For a posterior crossbite that’s skeletal in nature, while it’s never too late to have it fixed, getting treatment during childhood or the early teen years will help you achieve the best results more quickly and less invasively. This is because, before jaw growth is complete, we’re still able to widen the upper jaw. 

In the past, treating a severe posterior crossbite in an adult would have required corrective jaw surgery, or orthognathic surgery, along with orthodontic treatment. However, thanks to advances in technology and treatments, we can fix a crossbite in an adult without surgery in more cases than ever before.

How to Fix a Crossbite


Can Invisalign fix a crossbite? Yes, Invisalign can fix a crossbite in certain cases. If you have an anterior crossbite or a single-tooth crossbite, Invisalign or Invisalign Teen will be super effective. For some patients with a posterior crossbite, braces are the better option. 

If clear aligners are used, we may need to pair your aligners with Invisalign attachments. These tooth-colored buttons are bonded to your teeth and act almost like a handlebar for your aligners to push off in order to achieve more complex tooth movements. Invisalign rubber bands could be needed too. Rubber bands provide the connective force necessary to improve your bite, or the way your upper and lower teeth meet.


We can fix a crossbite with metal braces or clear braces. In fact, certain types of crossbite respond better to braces, usually along with rubber bands, than Invisalign. Whether we use braces alone or in combination with other treatments and appliances will depend on the severity of your crossbite and whether it’s skeletal or related to the position of your teeth.

Auxiliaries and Orthodontic Appliances

When treating a posterior crossbite with braces or Invisalign, we may need some help from auxiliaries like rubber bands and/or Invisalign attachments. In preteen and teenage patients who are still growing, we sometimes pair braces or Invisalign Teen with an orthodontic appliance to expand the jaw at the same time that we straighten the teeth. 

Other patients may respond well to using innovations like temporary anchorage devices (TADs) with their braces. TADs are an alternative to headgear and give Dr. Chan a fixed anchor point from which to achieve complicated tooth movements, including asymmetrical tooth movements, more efficiently and comfortably.

How Much Does Crossbite Treatment Cost?

The cost of crossbite correction is determined by how severe the problem is and your treatment plan. Once you come in for a free consultation at our practice and Dr. Chan develops a diagnosis and treatment recommendations, we’ll be able to provide you with the cost. 

At Richard Chan Orthodontics, we pride ourselves on offering high quality care for an affordable price. We accept most insurance plans, will help you determine your coverage and even file claims on your behalf. We also offer flexible, in-office financing, including braces and Invisalign for as low as $129 per month.

Crossbite Correction in Mill Creek, Bothell and Monroe, WA and Juneau, AK

If you think your child has a crossbite, or you have one yourself, schedule a complimentary consultation at Richard Chan Orthodontics in Mill Creek, Bothell and Monroe, WA or Juneau, AK. At your consultation, Dr. Chan will evaluate your diagnostic records and perform an exam to determine an accurate diagnosis. He can then create a personalized treatment plan to fix the crossbite and help you or your child achieve optimal oral health and function.

Second Opinion

Should I Get a Second Opinion From an Orthodontist?

By Community, Orthodontics No Comments

While general dentists and online companies sometimes offer teeth-straightening services, getting care from an orthodontic specialist is key. A certified specialist in orthodontics undergoes extensive training after dental school solely focused on preventing, diagnosing and treating irregularities of the teeth and jaw

But how do you go about finding a good orthodontist? And, should you get more than one opinion? Juneau, Bothell, Monroe and Mill Creek orthodontist Dr. Richard Chan is weighing in on the topic. 

Why Should You Get a Second Orthodontist Opinion?

Orthodontists, just like any type of doctor, can have different opinions about a diagnosis and different preferences when it comes to treatments. The cost of braces or Invisalign®, the length of treatment, the technology used, and the insurance plans they accept can also vary depending on the practice. 

If you visit an orthodontist for a consultation, you love the office, and you’re happy with the proposed treatment plan and fees, you might not need a second opinion. However, getting a second orthodontist’s opinion can be incredibly helpful if:

  • You don’t feel a connection with the doctor or team members.
    Orthodontic treatment is an investment and you’ll spend a good amount of time at your orthodontist’s office. You should feel comfortable and confident that the orthodontist and staff have your best interest at heart. Ultimately, you’ll want your smile journey to be a positive experience. Dreading every appointment will make you miserable.If the doctor or team members aren’t accommodating, don’t take the time to listen to your concerns or needs, or your instincts are telling you that it’s not a good fit, schedule an orthodontic consultation at another practice before committing.
  • The practice doesn’t use modern technology.
    Dated decor is one thing, but dated technology is entirely different. When a doctor is still using old technology and older treatments, it means that they haven’t kept up with innovations in orthodontics. It will impact your results, your treatment experience and, in some cases, even your oral health.Getting braces or Invisalign from an orthodontist who stays on the leading-edge of the field will help you achieve the best outcome more efficiently and comfortably. So, consider scheduling another visit at a more modern practice.
  • You’re told your young child needs lengthy interceptive orthodontic treatment.
    Interceptive orthodontic treatment, also called early orthodontic treatment or phase 1 orthodontic treatment, has become more popular over the years. This is where the orthodontist uses appliances while a child is still growing and has some baby teeth to guide jaw development and make room for the permanent teeth to erupt properly.There are absolutely cases where interceptive orthodontic treatment will help your child get the most stable results and avoid the need for jaw surgery or extractions later. However, often times, we can achieve outstanding results without interceptive treatment.At Richard Chan Orthodontics, we treat young patients very conservatively and only recommend phase 1 treatment in rare cases. So, we’d highly recommend a second orthodontist’s opinion if you’ve been told your child needs early interceptive orthodontic treatment, especially if the treatment seems long, elaborate or unnecessary.
  • You’re diagnosed with a complex orthodontic problem that will require extensive and/or costly treatment.
    If you have a complex case and the treatment plan is expensive or complicated (i.e., involves tooth extractions, years in braces, etc.), it doesn’t hurt to get another quote. This will help you decide if the costs and treatment plan are reasonable.
  • The orthodontist recommends surgical orthodontics.
    Surgical orthodontics is when we combine braces or Invisalign with corrective jaw surgery. It’s reserved for adult patients with certain severe skeletal issues that can’t be corrected with braces or Invisalign on their own. The process takes several years, involves major surgery and a serious recovery period, and it can be expensive.While sometimes it is the best option, whenever surgery is involved, you should always get a second opinion. With today’s technology and techniques, surgical orthodontics is becoming less common and many cases that would have required surgery in the past can be treated with orthodontics alone.
  • You’re told you’re not a candidate for Invisalign.
    A second Invisalign opinion is important if it was determined that you’re not a candidate for clear aligners. Of course, some orthodontic problems respond better to one treatment versus another.However, many times, patients are told Invisalign won’t work for them because the orthodontist doesn’t have the product familiarity or case experience to feel comfortable using the treatment for anything more than a mild issue. Getting a second Invisalign opinion from an experienced provider could mean that you can actually get clear aligners without compromising your results. Today more and more complex cases can be treated with Invisalign.
  • You don’t feel confident about the treatment plan, cost of braces or Invisalign, or any other aspect of your care.
    Listen to your instincts. It’s your smile and oral health, and you shouldn’t feel bad about wanting a second opinion from an orthodontist. If you’re not comfortable about any aspect of a proposed treatment plan or a practice, schedule a consultation at another orthodontic office.

Does Insurance Cover a Second Opinion on Braces or Invisalign Treatment?

Insurance coverage for orthodontic treatment varies greatly depending on the dental insurance plan. You’ll want to check with your insurance provider about coverage for treatment, as well as diagnostics, consultations, and second opinions on braces or Invisalign. 

That said, many orthodontists offer free consultations and second opinions, Richard Chan Orthodontics included. Whether you have insurance or not, the exam, diagnostic records, and treatment recommendations are complementary at our practice. 

If you’re wondering how to get a second opinion from an orthodontist, in most cases, it’s as simple as calling the practice and scheduling a consultation. We can’t speak for every office, but at ours, no referral is necessary to book a visit. 

How to Choose a Good Orthodontist

Here are some things to look for when choosing an orthodontist:

  • Location
    Even if you find the best orthodontist, if the office is an hour away, committing to appointments can be tough. At Richard Chan Orthodontics, we have convenient locations in Bothell, Monroe and Mill Creek, WA and Juneau, AK. You can choose the office that’s closest to you.
  • Orthodontist’s Training and Experience
    Be sure the doctor you’re seeing is a certified specialist in orthodontics. Don’t be afraid to ask how long they’ve been practicing and if they’ve treated cases like yours before.
  • Braces or Invisalign Cost
    When Dr. Chan started Richard Chan Orthodontics, his goal was to make high quality treatment accessible to everyone. Our braces and Invisalign are affordable and we accept most insurance plans. We also offer flexible, in-office financing options, including braces and Invisalign for as low as $129 per month.While the braces and Invisalign cost will vary depending on the severity of your case, the practice, your location, and other factors, you shouldn’t have to feel stressed about affording it. When you have treatment that works for your budget, you can focus on doing your part to get great results instead of worrying about the cost.
  • Modern Technology
    When choosing an orthodontist, ask about the technology the practice uses. Orthodontic technology has really evolved and staying up-to-date on it is essential. At our practice, we use advances like digital x-rays, the iTero digital scanner, treatment planning software, and even 3D printers. This allows Dr. Chan to design a smile for you based on your unique facial features. It also helps him achieve the results he promised in a way that’s safe, comfortable, and effective.
  • Treatment Options
    Being happy with your treatment modality will make for a better experience. If you have your heart set on clear braces, be sure the orthodontist offers them. If you want Invisalign, check that the orthodontist is an experienced Invisalign provider.
  • Clean Office
    The pandemic really put a spotlight on hygiene and disinfection practices. But, the truth is, that has always been important in oral health fields. You want an office that’s clean and follows all guidelines for infection control. Any good orthodontist will make your safety a top priority.
  • Friendly Team
    Last, but not least, when choosing an orthodontist, look for a practice with a friendly, welcoming team. If the doctor and staff are nice, informative, and willing to answer your questions, it’s a good indicator of the kind of care they’ll offer.

Book a Free Second Opinion at Richard Chan Orthodontics

The bottom line is, you should feel confident and informed about your treatment and excited to get started. If you’re unsure of an orthodontist’s diagnosis or treatment plan, schedule a complimentary second opinion with our Juneau, AK or Monroe, Bothell, Mill Creek/Everett, WA orthodontist today! There’s nothing to lose with this no-obligation, no-pressure visit and peace of mind to gain. Still need a first opinion? Schedule a complimentary consultation here.

Brush Your Teeth Before Breakfast

10 Habits That Could be Harming Your Teeth

By Dental Care, Orthodontics No Comments

At Richard Chan Orthodontics, we always teach our patients how to keep their teeth healthy so they can make the most out of their treatment. After all, no one wants to invest in braces or Invisalign® and then do something to harm their smile.

Of course, there are obvious things like not brushing or flossing your teeth that will have a negative impact on your oral health. But, there are also a number of common habits and practices that you might not think twice about that can damage teeth too. In this post, Dr. Richard Chan will be sharing what these habits are and how they can affect your smile.

1. Grinding Teeth

Teeth grinding and clenching, called bruxism, can have a significant effect on your teeth. While a mild, daytime teeth grinding habit might not be a huge concern, chronic bruxism, especially if you grind your teeth at night, will cause complications if not addressed.

Teeth grinding often results in excessive wear of the enamel, chipped or fractured teeth, damaged restorations, headaches, pain, temporomandibular joint (TMJ) dysfunction, earaches, loose teeth and more.

Wearing a night guard will help prevent complications by providing cushioning against the grinding forces. Depending on the cause of bruxism, additional treatment could be needed to help stop the habit and minimize or correct teeth grinding damage.

2. Chewing on Ice, Pencils or Other Objects

What does chewing on ice do to your teeth? First, it can wear away your enamel, which protects your teeth from cavity-causing acids. As enamel erodes, teeth are more susceptible to decay, they become sensitive to hot and cold and, if the underlying dentin is exposed, they can even look yellow. Chewing on ice is also a culprit behind cracked and chipped teeth and worn-down bite edges.

Chewing on pens, pencils, fingernails and other hard objects will probably have the same outcome. Hard plastics like pens or anything with sharp edges can lead to hairline cracks in the enamel and injure the soft tissues of the mouth. Plus, any time you put objects in your mouth, you’re also introducing germs.

3. Eating Lots of Starchy Foods Like Potato Chips and Crackers

There’s always a lot of talk about sugar and teeth. But, the bacteria in the mouth feed on carbohydrates, meaning both sugars and starches. When they do, they release acids that leach minerals from the tooth enamel. Frequent acid attacks cause tooth decay. As tooth decay progresses, a hole forms in the tooth, which is what we call a cavity.

In addition to containing carbohydrates, whether or not a specific food is likely to cause cavities also depends on how long it will be in contact with the teeth and how fast the food is eaten.

Starchy foods like potato chips and pretzels are heavy on the carbs, tend to be snacked on at a leisurely pace and get stuck in the teeth. So, they check all of the cavity-causing boxes. In fact, if you’re in the mood for a treat, when it comes to harming your teeth, you’d be better off having a scoop of ice cream than you would a handful of crackers since ice cream is eaten quickly and rinses off the teeth easily.

4. Not Wearing a Mouthguard When Playing Sports

It’s important to wear a mouthguard during any sport or physical activity that could result in a blow to the mouth. Unfortunately, only a handful of sports require a mouthguard, though a large number of dental injuries occur during basketball and baseball where mouthguards aren’t typically worn.

Common orofacial injuries include cuts to the soft tissues of the mouth, chipped, fractured or knocked out teeth and/or a broken jaw. Wearing a mouthguard is a proven way to reduce these types of injury and keep your smile safe. If you have braces, wearing a mouthguard is especially crucial as an injury can damage your appliance and the brackets and wires can cause even more extensive trauma to your mouth.

5. Drinking Soft Drinks, Energy Drinks or Sports Drinks

While you can drink soda with braces, we always encourage moderation because soda is one of the worst drinks for your teeth. It contains a large amount of sugar, giving fuel to your oral bacteria and causing them to release acids. Soda also contains acids itself, including citric acid. Citric acid is bad for your teeth in large amounts because it causes enamel erosion. The one-two punch of sugar and acidity is a major contributor to tooth decay.

Is diet soda better for your teeth? Nope. While you skip the sugar, it still leads to acid erosion. Some diet drinks have more acidity because of the artificial sweeteners. In fact, a study on enamel dissolution from various beverages found no difference between regular and diet versions of the same brand.

Energy drinks, sports drinks, bottled iced tea and lemonade tend to be up there with soda too, as they’re all acidic and high in sugar. The same study on enamel dissolution found that canned iced tea actually caused more enamel erosion than most soda, with the exception of Mountain Dew and Sprite.

The effects of acid on enamel are cumulative, so the prolonged exposure inherent in sipping a carbonated drink makes you more likely to experience teeth damage. Your best bet is to drink plain water. If you do have a soft drink, enjoy a small glass as part of a larger meal and rinse your teeth with water when you finish.

6. Brushing Your Teeth Right After Having Something Acidic

Speaking of acidity, as part of a balanced diet things like tea and citrus fruits are fine and, in the case of fruit, even beneficial. But if you do have something acidic, when you brush your teeth matters. So, should you brush your teeth before or after coffee or your morning orange juice? The answer is, before!

That might sound counterintuitive, but the acidity weakens your enamel for about 30 minutes to an hour after eating or drinking. If you brush your teeth before the pH in your mouth returns to normal, you can inadvertently cause further damage to your enamel while it’s in its temporarily weakened state.

Instead, brush your teeth before breakfast and then rinse your mouth out with water afterwards. If you’re prone to coffee breath, you can chew a piece of sugarless gum to get rid of the odor and encourage saliva production. Or, if you’re not in a rush, wait an hour after having coffee, juice or acidic foods to brush.

7. Using Your Teeth as a Tool

It can be tempting to use your teeth to tear open a plastic package or rip a stubborn tag off, but the habit increases your risk of teeth damage. Using your teeth as a tool can weaken them and cause chips or cracks, leading to pain, infection and aesthetic concerns. Preserve your pearly whites by using scissors instead.

8. Constant Snacking or Sipping

How often you eat and drink is nearly as important as what you eat and drink. Again, every time you eat, plaque bacteria feed on the sugars and starches and release cavity-causing acids. It takes 30 minutes to an hour for your saliva to neutralize the acidity in your mouth. Every sip and bite starts the clock over again, exposing your teeth to more acids.

Snacking also produces less saliva than eating a full meal does. This means food bits aren’t as effectively rinsed away and they sit on the teeth for a longer period of time.

To prevent tooth decay and damage to your teeth, minimize snacking and sipping on anything aside from water. When you do snack, eat something that’s smile friendly and low in carbohydrates like nuts, cheese or carrot sticks. Have sugary or starchy foods and drinks with a meal, so your saliva production is in full gear in order to promote remineralization and whisk away debris.

9. Frequently Indulging in Chewy and Sticky Treats

Just as with the starchy things like chips or crackers, chewy and sticky foods stick in the teeth, making you more susceptible to cavities. Raisins and other dried fruits and gummy bears, Sour Patch Kids, Starburst and other candies are especially harmful because they also contain sugar.

10. Sucking on Hard Candies or Cough Drops With Sugar

As long as you don’t chew them, hard candies, lollipops and cough drops should be better for your teeth since they dissolve and won’t get stuck in the nooks and crannies, right? Unfortunately, no.

These types of foods are high in sugar and still expose your teeth to carbohydrates and acid attacks. Since you’re sucking on them and they dissolve slowly, exposure is prolonged. Steer clear of hard candy and lollipops or opt for sugarless varieties (bonus points if they contain xylitol, which helps fight cavities). If you’re sick and need cough drops, look for sugarless ones or at least rinse your mouth out with water after having one.

Are You Ready to Experience Amazing Oral Health?

Aside from avoiding these teeth damaging habits, you can also improve your oral health with orthodontic treatment. Straight teeth are easier to clean and an aligned bite keeps your jaw healthy and strong. To find out your options for braces or Invisalign in Bothell, Monroe or Mill Creek, WA or Juneau, AK, schedule a complimentary consultation at Richard Chan Orthodontics today!

Teeth grinding guard for braces

Can I Get Braces or Invisalign® if I Grind My Teeth?

By Invisalign, Orthodontics No Comments

Teeth grinding or clenching, technically called bruxism, is common. If you’re one of the millions of people with bruxism, you might be wondering if you can still get braces or Invisalign. Will teeth grinding wear your aligners out? Will you be able to find a teeth grinding guard for braces? In this post, our Juneau, AK and Bothell, Monroe and Mill Creek, WA orthodontist, Dr. Richard Chan, will be going over everything you need to know about bruxism and orthodontic treatment. 

What Causes Teeth Grinding?

There are two types of bruxism: awake bruxism and sleep bruxism. With awake bruxism, you unconsciously clench or grind your teeth while you’re awake. Clenching and grinding teeth in sleep is known as sleep bruxism. 

As for what causes teeth grinding, experts believe it can be due:

  • Stress, anxiety, anger or frustration (awake bruxism is often tied to emotions)
  • Genetics (sleep bruxism tends to run in families)
  • Sleep apnea and other sleep disorders
  • Certain medications
  • Substances (i.e., caffeine, alcohol, tobacco products, etc.)
  • Health conditions, including GERD, Parkinson’s disease, dementia and ADHD
  • Misaligned teeth and bite problems

Complications of Bruxism

Most people don’t need treatment for awake bruxism or occasional, mild sleep bruxism. If you’re chronically grinding your teeth in sleep, on the other hand, it should be treated, because it can cause:

  • Excessive wear of the enamel
  • Fractured or chipped teeth
  • Damaged dental restorations
  • Temporomandibular joint (TMJ) dysfunction and pain
  • Headaches
  • Earaches
  • Pain when chewing
  • Loose teeth
  • Difficulty sleeping

According to Cedars Sinai, many people don’t realize they are grinding their teeth during sleep until a sleep partner mentions it, they wake up with sore facial muscles and stiffness, or a dentist notices certain wear patterns on the teeth. 

Can You Wear Invisalign if You Grind Your Teeth?

Yes, most patients can get Invisalign if they grind their teeth. Chronic teeth grinding with Invisalign could cause the aligners to wear down more quickly. However, since you only wear each set of aligners for one to two weeks, by the time you’re in need of a replacement, you’ll usually be on to your next tray. 

There are rare occasions where someone’s bruxism is so severe that they would wear out their aligners before it was time to change them. In these cases, we will ask Invisalign to give us two sets of each aligner, or getting braces could be the better option. But one advantage of Invisalign is that while you might be grinding your trays down, at least you won’t be grinding your teeth down!

What About Braces and Teeth Grinding?

Yup, you can get braces if you grind your teeth. As we mentioned above, occasionally, braces could be preferable to Invisalign for patients with severe bruxism. 

Will Braces or Invisalign Help With Teeth Grinding?

Whether or not braces or Invisalign can help with teeth grinding depends on what’s causing your bruxism. Bruxism is more prevalent in people with misaligned teeth and, if that’s the case for you, then aligning your teeth with orthodontic treatment will help to reduce the behavior. 

If you grind your teeth when you’re awake, Invisalign aligners can serve as a reminder, making you more aware of the habit. This too can be beneficial for reducing or stopping grinding and clenching. 

It’s important to note though that for some orthodontic patients, teeth grinding gets worse before it gets better. The mild sensitivity that occurs when you start treatment, as well as the shifting of your teeth, can temporarily increase grinding and clenching.  For this same reason sometimes the bruxism will decrease at the beginning of the treatment, as the increase in sensitivity will cause an automatic feedback to stop grinding the teeth.  

Can Invisalign Be Used as a Night Guard?

When it comes to how to stop teeth grinding, a multi-disciplinary approach is often best. Managing the underlying cause of your teeth grinding is important, whether it’s treating a health condition or finding new ways to cope with stress. Additionally, a lot of people also benefit from a special mouth guard for teeth grinding, called a night guard. The appliance helps cushion against the biting or clenching forces to prevent damage to the teeth and jaw. 

If you’re straightening your teeth, can Invisalign be used as a night guard? During your treatment, yes, Invisalign can be used as a night guard to a certain extent. You can’t wear a night guard instead of your aligners because you need to wear your aligners for about 22 hours per day for optimal results. Your aligners are actually pretty similar in design to a night guard and will provide some cushion between the upper and lower teeth. 

Can I Get a Teeth Grinding Guard for Braces?

Since braces don’t cover the entire arch of teeth like aligners do, you can still wear a night guard during your braces treatment. In fact, wearing one will be in your best interest if your bruxism is severe and likely to damage your teeth, jaw and/or appliance. 

Keep in mind that your teeth will shift throughout your braces treatment. This means you’ll have to change your night guard so that it continues to fit. When choosing a teeth grinding guard for braces, a boil-and-bite or custom orthodontic guard will be the most affordable options. With an over-the-counter, boil-and-bite night guard, you can simply make a new one as needed. A custom orthodontic guard will account for your appliance and allow for the movement of the teeth, so you won’t have to constantly replace it. 

Schedule a Complimentary Consultation at Richard Chan Orthodontics Today!

If you clench or grind your teeth and want to learn more about your orthodontic treatment options, schedule a complimentary consultation at our Juneau, AK or Bothell, Mill Creek or Monroe, WA orthodontics office. Dr. Chan will perform a comprehensive exam and assess your diagnostic records in order to provide you with personalized treatment recommendations that will bring out the best in your smile.

A Guide to Preparing Your Child for Braces or Invisalign® Teen

A Guide to Preparing Your Child for Braces or Invisalign® Teen

By Orthodontics, Teen Orthodontics No Comments

When your child first finds out they’ll be getting braces or Invisalign Teen, they’re likely going to have a lot of questions. They might be nervous about the treatment being painful or embarrassed to be the only person in class with braces (fact: they won’t be!). They might be frustrated about the rules of what they can and can’t eat, and how to brush and floss their teeth. We get these questions all the time at Richard Chan Orthodontics, both from our teen patients and their parents. In most cases, kids are simply afraid of the unknown. As parents, you can play a big role in helping them understand what to expect and prepare them as best as possible.

As your child gets ready to start his or her orthodontic treatment, there are many things you can do to ease their concerns and even get them excited (yes, really!). And if you ever have questions, just call your Monroe, Mill Creek, Bothell and Juneau orthodontist. Dr. Richard Chan  and our team are always here to help.

1. Learn All About Braces and Invisalign Together

Beginning any orthodontic treatment can feel a little overwhelming, not only for kids and teens but for their parents too. The first step in preparing for braces or Invisalign is to learn as much as possible about treatment before it actually starts. Research what your child will need to know from the foods they can eat to how to brush and floss. Better yet, get educated together so the whole family knows what to expect. When you’ve done thorough research and discussed all of your child’s treatment options, everyone will feel better equipped to take on life with braces.

2. Let Them Know They’re Not Alone

Many kids don’t want braces or Invisalign, because they think they’ll be the only one they know going through it. But did you know an estimated 80% of teens will have some sort of orthodontic treatment? Chances are your child already has a few friends or classmates with braces or Invisalign. Maybe you even had braces yourself way back when. Reminding your kids that they’re not alone (and that treatment can be a positive experience) can help them get more comfortable with the idea of getting braces.

There are also many celebrities who had braces, even when they were already in the public eye. Drew Barrymore, Kendall Jenner and Dakota Fanning are just a few of Hollywood’s biggest names who straightened their teeth. Once your kids see how common braces are for everyone, they’ll feel better about their own treatment. And seeing the results of braces on the big screen is also an added benefit!

3. Stock the Fridge with Soft Foods

Adapting to life with braces is about more than getting used to seeing a new smile in the mirror. Your kids will also have to adjust their eating habits to make sure they get the most out of their treatment. There are a number of foods to avoid when you have braces, including sticky, chewy, hard, or crunchy foods, or anything you have to bite into (such as apples, corn on the cob or whole raw carrots). 

As a parent, you can make their lives easier by stocking up on and preparing braces-friendly foods. Soft things like yogurt, fruit, soups, smoothies, steamed veggies or ice cream are perfect foods for people with braces, because they’re easy to chew and won’t get caught in your child’s appliance. The best part is that braces-safe foods are usually super healthy, so the whole family can benefit from a braces-friendly diet!

4. Plan Ahead for Discomfort

On top of learning what they can and cannot eat, your child will also have to get used to the feel of braces or Invisalign. With any orthodontic treatment, there can be mild discomfort as the teeth shift and move to their desired position. Braces can cause additional irritation to your child’s lips or the inside of their mouth. Parents can help their kids cope by having orthodontic wax and mild, over-the-counter pain relievers on hand. 

Have your kids take a child-safe medication like Advil before getting their braces tightened or when they’re switching to a new set of Invisalign Teen aligners. If their brackets are causing sores, place orthodontic wax over the uncomfortable part of the braces to reduce irritation. Being proactive about managing discomfort will ensure your kids have a much more positive experience with braces or Invisalign.

 5. Put Together An Invisalign or Braces Emergency Kit

Speaking of planning ahead, putting together an Invisalign or braces emergency kit is the key to being ready for any situation and keeping teeth clean while on the go. Store these items in a toiletry or cosmetic bag and have your child keep the kit on them when they’re at school or activities:
A Travel Toothbrush and Toothpaste

  • A Travel Toothbrush and Toothpaste
    Kids will want to brush their teeth after eating to get rid of any food debris that’s stuck in their hardware. Even those with Invisalign Teen should brush after eating, so their teeth are clean when they put their clear aligners back in.
  • Flossing Tools
    If your child or teen will be getting braces, don’t forget to add dental floss and a floss threader or special orthodontic flossers to their kit. Flossing can get rid of stubborn food that refuses to budge with a toothbrush. Interdental brushes, also called interproximal brushes, are a good addition too. These tiny brushes are able to clean around brackets and can be used to dislodge food.
  • Orthodontic Wax
    As mentioned above, braces wax is effective for stopping irritation and it can be used for minor braces emergencies like a poking wire or broken bracket.
  • Tissues
    Keeping tissues on hand ensures kids can quickly wipe away any spit when they take out their Invisalign aligners. Tissues can also be used to dry off areas of the braces that are causing irritation before applying wax.
  • Hand Sanitizer
    Encourage kids and teens to thoroughly wash their hands before removing or putting in their aligners or applying wax to their braces. If they’re not able to find soap and a sink, hand sanitizer will do the trick.
  • Lip Balm
    Include lip balm for braces and Invisalign wearers. When you have braces or are wearing aligners or a retainer, the lips stretch a bit to fit over the appliance, which can cause or worsen dryness and cracking. Sometimes, after braces adjustments, the lips can feel a bit dry too. Using lip balm will keep lips hydrated and help with any irritation. The best lip balm for braces or Invisalign is one that’s rich and soothing like Burt’s Bees 100% Natural Beeswax Lip Balm or Carmex.
  • Water
    While it might not fit in your child’s braces or Invisalign kit, be sure they bring their reusable water bottle with them when they leave the house. Kids can swish with water after meals and snacks if they forget their toothbrush or after having a sugary beverage. Staying hydrated by drinking water also stimulates the flow of saliva, which helps remineralize teeth and wash away food and plaque to keep cavities away.

6. Set Up A System of Small Rewards

As a parent, you know the real reward for keeping braces clean or wearing clear aligners or rubber bands for the prescribed amount of time is a healthy smile. However, kids and teens don’t always fully appreciate these long-term benefits. That’s why we recommend using a system of small rewards to help kids establish positive habits. Setting your expectations and figuring out a rewards system before kids start treatment will be helpful. 

Think about what motivates your child and then use it to temporarily reward them until the desired habit (i.e., diligently brushing and flossing with braces, wearing Invisalign Teen aligners or rubber bands for 22 hours per day, etc.) is firmly in place. 

For example, you could reward your kiddo with 15 minutes of extra screen time each day they brush their teeth for two full minutes after meals and snacks. Or, they could earn a ticket every time they wear their aligners for 22 hours. When they collect 10 tickets, they then get to go somewhere fun or order takeout from the restaurant of their choice. Get creative and find what works for your family! 

7. Focus on the End Goal

We all know that kids can be impatient and during orthodontic treatment is no different. Your kids will probably be counting down the days until their braces come off or when they can put away their aligners for good. Depending on their length of treatment, they’ll have many months to wait, which can make it hard for them to see how their oral hygiene habits today will impact results down the line. 

To keep them motivated, help them look ahead to the end of treatment when they’ll get to see their perfect smile. Focusing on the outcome will encourage them to stay on track and comply with their orthodontist’s instructions. And before they know it, they’ll be able to proudly show off their brand new smile.

Let’s Work Together to Give Your Child a Healthy, Beautiful Smile!

Still have questions about preparing your child for orthodontic treatment? Whether you want more details about oral hygiene or you’d like additional recommendations for things like the best toothpaste or lip balm for braces, contact us and we’ll be happy to help.

If you’re interested in finding out your child or teenager’s teeth-straightening options, schedule a complimentary consultation at Richard Chan Orthodontics in Bothell, Monroe or Mill Creek, WA or Juneau, AK today!

causes of crooked teeth

8 Common Causes of Crooked Teeth

By Orthodontics No Comments

There’s always that one friend or family member with perfectly straight teeth who never needed braces or Invisalign. It can make you wonder how that’s possible and what’s behind your own misaligned teeth or jaw.

Are crooked teeth genetic? Why do some people have crooked teeth while others don’t? Can misalignment be prevented? In this post, our Bothell, Monroe, Mill Creek, Everett and Juneau orthodontist will be diving into 8 common causes of crooked teeth and what you can do about it.

Are Crooked Teeth in Kids Always a Concern?

Before we cover the causes of crooked teeth, let’s talk about primary teeth. Parents sometimes panic when their child’s teeth aren’t straight, but crooked teeth in kids are not always indicative of a problem.

If your kiddo has crooked baby teeth, they won’t necessarily have crooked permanent teeth. This is especially true for spacing. Spaces or gaps between baby teeth can be a good thing since the permanent teeth are larger and will take up more room once they erupt. For this same reason, however, if your child has significantly crowded baby teeth, there is a chance that the permanent teeth will be crowded too.

The American Association of Orthodontists recommends children have their first orthodontic evaluation by age 7. This might sound really young, but it’s for a good reason. At this age, Dr. Chan can see how your child’s bite is shaping up. We always treat kids conservatively at our practice and most won’t need treatment right away. They’ll simply come in occasionally over the years, so we can pinpoint the ideal time for them to start braces or Invisalign when they’re teenagers.

However, if Dr. Chan does identify red flags like abnormalities with jaw or facial growth or severe crowding, sometimes, intervening early will bring about the best results. In certain cases, he may recommend phase 1 orthodontic treatment, which is when we use orthodontic appliances to guide jaw and facial growth (dentofacial orthopedics) while a child is still developing.

The goal is to correct any skeletal abnormalities and make room for the permanent teeth to come in correctly. When early orthodontic treatment is necessary, it can make later treatment easier and prevent the need for corrective jaw surgery or the extraction of permanent teeth.

Other times, if we identify myofunctional or oral habits (i.e., thumb sucking, tongue thrust, mouth breathing, etc.), which we’ll talk about shortly, we can give parents guidance on correcting the habit. Stopping the habit might not prevent crooked teeth entirely, but it may ward off more serious malocclusion (improper bite) that would require extensive treatment.

What Causes Crooked Teeth?

So, what causes crooked teeth? Here are 8 common culprits:

  1. Genetics
    For a lot of patients, crooked teeth are genetic. If one or both of your parents have crooked teeth, you could also have crooked teeth. The different types of malocclusion, such as an overbite, underbite, open bite and crossbite, while sometimes caused or worsened by oral habits, are often due to the size or position of the jaw. The size of our jaws and teeth are determined by genetics, but they often do not match each other. For example, we might get a smaller jaw from one side of the family, and then larger teeth from the other side, resulting in excess crowding. Or, if the opposite happens, and we get larger jaws with smaller teeth, then we will have excess spacing.
  2. Oral Habits
    Repetitive oral habits like thumb sucking or prolonged pacifier use, especially if the habit continues once the permanent teeth start to erupt, can also be a cause of crooked teeth and a misaligned bite. As a child sucks on their thumb or pacifier, they exert pressure behind the top front teeth. This pressure can cause changes in their palate, as well as lead to protruding or overjet teeth and issues like an open bite.
  3. Orofacial Myofunctional Disorders
    Orofacial (mouth and face) myofunctional (muscle function) disorders, such as mouth breathing and tongue posturing, are also common causes of crooked teeth. When kids have trouble breathing through their nose, whether due to an airway problem or even allergies, they may resort to mouth breathing. Chronic mouth breathing, in turn, can cause problems with their facial development, leading to crooked teeth and all types of malocclusion.
    Tongue thrust, also called reverse swallowing or immature swallowing, is when the tongue hits against or protrudes in between the front teeth when a person swallows or talks. Although the thrusting movement is not enough to cause crooked teeth, the tongue will usually stay in a forward position when at rest too, which does cause problems. Inside of the mouth, the tongue puts pressure against the teeth while, from the outside, the facial muscles exert pressure. The combination can interfere with craniofacial development and cause crooked teeth and bite issues.
  4. The Early Loss of Primary Teeth
    The primary teeth, or baby teeth, are important. It can seem like no big deal if a child loses a baby tooth early since it would have fallen out anyway, but that’s not the case. The baby teeth help with facial and speech development, aid in chewing and, most importantly, save space for the permanent teeth to come in. When a baby tooth is lost before it’s supposed to fall out, and a space maintainer isn’t placed, the remaining teeth will shift into the gap. The permanent tooth won’t be able to erupt correctly and, in extreme cases, can even become impacted (stuck under the tissue or bone), leading to crowding.
  5. Trauma
    Sustaining a dental injury like an elbow to the mouth while playing sports can displace the teeth. If not treated, not only can the one tooth become crooked, but the other teeth may shift to accommodate the damaged tooth.
  6. Not Replacing Missing Permanent Teeth
    If you lose a permanent tooth from periodontal disease, severe decay, an injury or a health condition, it’s essential to replace it with a dental implant or a restoration like a dental bridge. This is because, just like we talked about with a missing baby tooth, when you have a missing permanent tooth that isn’t replaced, the remaining teeth will shift into the space left behind. This will create changes in your bite and can ultimately cause crooked teeth.
    Additionally, since the jawbone isn’t being stimulated anymore where the tooth is missing, the body will resorb the bone. This bone loss might also impact the alignment of your teeth and even the appearance of your face.
  7. Natural Changes With Age
    As we get older, the bite often deepens and the teeth tend to shift naturally. This is why wearing a retainer after braces or Invisalign is the key to maintaining your results. If you forget to wear your retainer, over time, you will experience a relapse. Even if you didn’t need braces or Invisalign before, you might find that your teeth become crooked as you get older.
  8. Dental Work
    Improperly fitting dental restorations like crowns, bridges and fillings can have a negative impact on your bite, causing pain and reduced function, as well as misaligned teeth.

Can Crooked Teeth be Prevented?

There’s no way to guarantee that you’ll have straight teeth and won’t need braces or Invisalign. Crooked teeth and a misaligned bite often have a genetic component and, if that’s the case, they can’t really be prevented.

That said, stopping oral habits such as thumb sucking and pacifier use and seeking out treatment for issues like tongue thrust/posture and mouth breathing, can prevent some bite issues or, at least, ensure they don’t continue to get worse.

Crowding can also be reduced or, sometimes, prevented, by opting for a dental space maintainer for a baby tooth that’s lost too early or by replacing a missing permanent tooth. Lastly, wearing a mouthguard when playing sports or doing any activity that could result in a blow to the face is good practice and will keep your teeth safe and where you want them.

Why Do Crooked Teeth Need to be Fixed?

There are times when slightly crooked teeth or a small gap can add charm to your smile and might not need to be corrected unless you feel self-conscious. But, the truth is, often, crooked teeth should be fixed because:

  • Most importantly, you want a beautiful smile, and your crooked teeth bother you.
  • Some of the teeth will bear more of the brunt when you chew, resulting in excessive or uneven wear of the enamel.
  • They can make chewing difficult or painful when they are in certain wrong positions.

How to Fix Crooked Teeth

We talked about the causes of crooked teeth, whether they’re a concern in kids and why they should be fixed. Now, let’s go over how to fix crooked teeth. The first step is visiting Richard Chan Orthodontics for a complimentary consultation.

We’ll take any necessary diagnostic records, like photos and digital x-rays, and Dr. Chan will complete a thorough examination. He’ll use his findings to develop an accurate diagnosis and personalized treatment recommendations.

Treatment options could include:

  • Metal BracesMetal braces are the original way to fix crooked teeth and they’re still around today, because they’re effective. Modern metal braces are smaller and more streamlined than those of the past. They’re an excellent treatment option for kids, teens and adults, including those with severe orthodontic issues. They tend to be super popular with our younger patients who love getting to personalize their braces with colorful elastics. We have the common silver metal braces, and we also have gold braces for those who prefer them!
  • Clear BracesClear braces, or ceramic braces, work in the same way as metal braces. However, the brackets are crafted from a durable ceramic material that blends in with your smile. They’re much less noticeable than their metal counterparts. Many of our adult braces patients prefer clear braces.
  • Invisalign or Invisalign TeenIf you’re wondering how to fix crooked teeth without braces, Invisalign could be the solution. The system of clear, removable aligners is a convenient, comfortable treatment option. Dr. Chan designs your ideal smile on a virtual, 3D model of your mouth and the aligners are custom-made for you based on his specifications. As you make your way through your aligners, your smile will gradually take shape. The aligners are virtually invisible and since they’re removable, there are no food restrictions and oral hygiene is simple.Invisalign Teen works in the same way as Invisalign for adults. However, the aligners are designed especially for younger patients with features including eruption tabs to accommodate erupting teeth and free replacement aligners included in the system.

Connect with Dr. Richard Chan Today!

If you’re concerned about crooked teeth and you’re ready to find out which treatment option will bring out the best in your smile, we can help. Schedule a complimentary consultation at our Bothell, Monroe or Mill Creek, WA or Juneau, AK orthodontic offices to get started.